For many healthcare service consumers understanding the processes, procedures, codes, calculations, and vocabulary associated with healthcare service claims is difficult and confusing. As a result, in many instances, when the healthcare service consumer receives a bill form a healthcare service provider or an Explanation Of Benefits (EOB) from a healthcare insurance provider, the healthcare service consumer often has no idea how the amount billed was generated and/or determined, how their share of the cost was generated and/or determined, and/or how to proceed if they disagree with either of these amounts. To a large degree this is because the healthcare service bills and/or EOBs are often written in medical terms not discernible by the average healthcare service consumer and/or use codes that are typically completely unfamiliar to the average healthcare service consumer.
This situation is particularly problematic when the healthcare service consumer is presented with a bill that is either not expected at all, or that is for an unexpected amount. In these instances, not only does the healthcare service consumer often fail to understand how the bill was generated, and/or why the bill is not for the amount expected, but, in many cases, the healthcare consumer has no idea what party to contact to discuss and/or challenge the bill, much less what department associated with a given party is needed.
For instance, when a bill is not understood and/or a perceived error is discovered, in many cases the healthcare service consumer does not know whether to contact the healthcare insurance provider, his or her healthcare service plan administrator, the healthcare service provider, the healthcare service consumer's employer, or even a collection agency that has contacted the healthcare consumer. For this reason alone, many healthcare service providers, healthcare insurance providers, employers, and/or healthcare service plan administrators lose precious time dealing with phone calls and letters from healthcare service consumers that have been incorrectly directed to their offices. This wasted time is in addition to the time wasted by the healthcare service consumers themselves attempting to determine who to contact, waiting on hold, navigating seemingly endless voicemail menus and automated responses, and then, often as not, being yet again redirected to a different contact to start the process over again.
In addition, even if the healthcare service consumer is able to contact a given party that may, or may not, be the right contact, they still often do not understand the information they have been provided from their bills and/or EOBs and often are unable to identify and/or provide the contacted party with the information regarding the bill that both they and the party will need to proceed. Indeed, the situation can be so confusing for some healthcare service consumers they do not even know how to describe their issues in a way that can allow any party to determine whether they are the proper contact or not.
As a result of the situation described above, not only are many healthcare service consumers forced to use their precious “free time” trying to deal with healthcare service disputes, and often only getting more frustration for their efforts, but, as noted, many healthcare service providers, healthcare insurance providers, employers, and/or plan administrators lose precious employee time dealing with phone calls and letters from healthcare service consumers who have incorrectly called their offices. Consequently, the current situation is far from ideal for virtually all parties involved in the healthcare industry, and often results in frustrated and angry healthcare service consumers.